Pediatric surgical oncology

This article highlights the surgeon's role in childhood cancer especially as it relates to local control of solid tumors, research, and surgical supportive care. There is a trend toward preresection chemotherapy, and rarely, radiotherapy. This may allow safer, less extensive, and function-preserving delayed resection in neuroblastoma, hepatoblastoma, bone tumors, and nephroblastoma in selected patients without negatively affecting outcome. Ultimately, complete resection for most tumors, even advanced neuroblastomas, significantly improves survival. Organ transplantation allows complete resection with good survival in children with otherwise nonresectable liver tumors. In non-Hodgkin's lymphoma, resection should not be attempted, except for localized disease and if complete resection is possible. Second-look procedures have limited value in lymphoma, but have an important role in germ cell tumors. The differentiation of typhlitis from appendicitis is critical in the neutropenic patient to avoid life-threatening complications. Studies of venous access devices show a clear benefit of totally implantable devices in preventing dislodgment and decreasing the rate of infection. Neuroblastoma models are fertile soil for research into tumor biology and novel treatment modalities. Surgeons continue to play crucial roles in childhood oncology.